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Traumatic Brain Injuries - TBI

Disabilities

Disabilities
resulting from a TBI depend upon the
severity of the injury, the location of the
injury, and the age and general health of
the patient. Some common disabilities
include problems with cognition
(thinking, memory, and reasoning),
sensory processing (sight, hearing,
touch, taste, and smell), communication
(expression and understanding), and
behavior or mental health (depression,
anxiety, personality changes, aggression,
acting out, and social inappropriateness).

Postconcussion Syndrome: Within days
to weeks of the head injury approximately 40
% of TBI patients develop a host of
troubling symptoms collectively called
postconcussion syndrome (PCS). A patient
need not have suffered a concussion or loss
of consciousness to develop the syndrome and
many patients with mild TBI suffer from PCS.
Symptoms include headache, dizziness, memory
problems, trouble concentrating, sleeping
problems, restlessness, irritability,
apathy, depression, and anxiety. These
symptoms may last for a few weeks after the
head injury. The syndrome is more prevalent
in patients who had psychiatric symptoms,
such as depression or anxiety, before the
injury. Treatment for PCS may include
medicines for pain and psychiatric
conditions, and psychotherapy and
occupational therapy.

Post-Traumatic Amnesia: Most
patients with severe TBI, if they recover
consciousness, suffer from cognitive
disabilities, including the loss of many
higher level mental skills. The most common
cognitive impairment among severely
head-injured patients is memory loss,
characterized by some loss of specific
memories and the partial inability to form
or store new ones. Some of these patients
may experience post-traumatic amnesia (PTA),
either anterograde or retrograde.
Anterograde PTA is impaired memory of events
that happened after the TBI, while
retrograde PTA is impaired memory of events
that happened before the TBI.

Cognitive Deficits: Many patients
with mild to moderate head injuries who
experience cognitive deficits become easily
confused or distracted and have problems
with concentration and attention. They also
have problems with higher level, so-called
executive functions, such as planning,
organizing, abstract reasoning, problem
solving, and making judgments, which may
make it difficult to resume pre-injury
work-related activities. Recovery from
cognitive deficits is greatest within the
first 6 months after the injury and more
gradual after that.

Patients with moderate to severe TBI have
more problems with cognitive deficits than
patients with mild TBI, but a history of
several mild TBIs may have an additive
effect, causing cognitive deficits equal to
a moderate or severe injury.

Sensory Problems: Many TBI patients
have sensory problems, especially problems
with vision. Patients may not be able to
register what they are seeing or may be slow
to recognize objects. Also, TBI patients
often have difficulty with hand-eye
coordination. Because of this, TBI patients
may seem clumsy or unsteady. Other sensory
deficits may include problems with hearing,
smell, taste, or touch. Some TBI patients
develop tinnitus, a ringing or roaring in
the ears. A person with damage to the part
of the brain that processes taste or smell
may develop a persistent bitter taste in the
mouth or perceive a persistent noxious
smell. Damage to the part of the brain that
controls the sense of touch may cause a TBI
patient to develop persistent skin tingling,
itching, or pain. These conditions are rare
and hard to treat.

Language and communication problems are
common disabilities in TBI patients. Some
may experience aphasia, defined as
difficulty with understanding and producing
spoken and written language; others may have
difficulty with the more subtle aspects of
communication, such as body language and
emotional, non-verbal signals.

Aphasia: In non-fluent aphasia, also
called Broca's aphasia or motor aphasia, TBI
patients often have trouble recalling words
and speaking in complete sentences. They may
speak in broken phrases and pause
frequently. Most patients are aware of these
deficits and may become extremely
frustrated.

Patients with fluent aphasia, also called
Wernicke's aphasia or sensory aphasia,
display little meaning in their speech, even
though they speak in complete sentences and
use correct grammar. Instead, they speak in
flowing gibberish, drawing out their
sentences with non-essential and invented
words. Many patients with fluent aphasia are
unaware that they make little sense and
become angry with others for not
understanding them. Patients with global
aphasia have extensive damage to the
portions of the brain responsible for
language and often suffer severe
communication disabilities.

Dysarthria: TBI patients may have
problems with spoken language if the part of
the brain that controls speech muscles is
damaged. In this disorder, called dysarthria,
the patient can think of the appropriate
language, but cannot easily speak the words
because they are unable to use the muscles
needed to form the words and produce the
sounds. Speech is often slow, slurred, and
garbled. Some may have problems with
intonation or inflection, called prosodic
dysfunction.

Psychiatric Problems: Most TBI
patients have emotional or behavioral
problems that fit under the broad category
of psychiatric health. Family members of TBI
patients often find that personality changes
and behavioral problems are the most
difficult disabilities to handle.
Psychiatric problems that may surface
include depression, apathy, anxiety,
irritability, anger, paranoia, confusion,
frustration, agitation, insomnia or other
sleep problems, and mood swings. Problem
behaviors may include aggression and
violence, impulsivity, disinhibition, acting
out, noncompliance, social
inappropriateness, emotional outbursts,
childish behavior, impaired self-control,
impaired selfawareness, inability to take
responsibility or accept criticism,
egocentrism, inappropriate sexual activity,
and alcohol or drug abuse/addiction. Some
patients' personality problems may be so
severe that they are diagnosed with organic
personality disorder, a psychiatric
condition characterized by many of the
problems mentioned above. Sometimes TBI
patients suffer from developmental
stagnation, meaning that they fail to mature
emotionally, socially, or psychologically
after the trauma. This is a serious problem
for children and young adults who suffer
from a TBI. Attitudes and behaviors that are
appropriate for a child or teenager become
inappropriate in adulthood. Many TBI
patients who show psychiatric or behavioral
problems can be helped with medication and
psychotherapy.